Objectives: This retrospective study evaluated the prognostic significance of the ratio of C-reactive protein (CRP) to albumin (Alb) in patients with biliary tract cancer (BTC). Methods: A total of 178 patients with newly diagnosed BTC, who had been treated in our departments between January 2013 and September 2018, were enrolled in the study. All medical records were reviewed retrospectively. Patients who showed clinical evidence of infection or other inflammatory conditions were excluded. We investigated the correlation between the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), CRP to Alb ratio (CAR) and the overall survival (OS) rates for BTC patients. Both univariate and multivariate analyses were performed to identify clinicopathological variables associated with OS. Results: The optimal cutoff level for the CAR was 0.66. An elevated CAR was associated with low OS (p<0.001). In the multivariate analysis CAR, was independently associated with OS (HR 3.44, 95% CI: 2.05-5.79, p<0.001). Median OS for CAR ?0.66 and CAR >0.66 were 22.0 months and 6.0 months, respectively. By contrast, NLR (p=0.12) and PLR (p=0.85) were not independently associated with OS. Conclusion: The CAR might be an independent prognostic marker for patients with BTC, and might have value comparable with other established inflammation-based prognostic scores. The prognostic value of this novel inflammationbased prognostic score needs to be verified in patients with other types of cancer. Keywords: Biliary tract cancer, C-Reactive protein to albumin ratio, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, prognostic score
Corresponding Author: Demir T.